Question: My parents are in their late 70’s and, of late, have been failing both mentally and physically. My father has fallen several times, and my mother has been getting lost while driving home from church. I have no brothers or sisters, and my folks’ neighbors have been expressing their concern. I was finally able to sit down with my parents and get them to understand that I was not trying to take away their independence, but only to help them live at home as long as possible.

My husband and I have four children, two of whom are still in college. We both work, and, as it has been said, “our plate is full”; however, we recognize the need to make sure my folks are watched over. I have been reading as much as I can about the options, and have become generally confused about what is available and when it should be used. Is there a “primer” available on this topic?

Answer: Based on our experience, you hit a “home run” for both you and your folks when you were able to convince them that they need help and that you are not trying to take away their independence. If you can keep this trust in your relationship, it will go a long way toward making the future transitions as seamless as possible.

Everyone wants to remain home for as long as possible, and studies show that remaining in the least restrictive environment for as long as possible carries with it the most benefit. But each family situation is impacted by different facts, including safety and economic concerns. Therefore, before you can begin to develop a long-term care plan, you must understand the options available.

As first steps, we recommend 1) a face to face by you and your parents with a geriatric care manager (www.caremanager.org) or click here who can assess your parents’ needs and assist the family, and 2) an appointment with a qualified elder law attorney (www.naela.org) or click here who can assess your parents’ legal documents and, where necessary, prepare health and financial powers of attorney, wills, and the like.

The term “long-term care” refers to the type of care required for persons who are physically or cognitively impaired or disabled to the degree that they can’t safely live or function without some level of assistance from others.

The basic levels of care, defined in the most simplistic terms, are, in order of severity:

Acute Care. If medical needs can only be provided for in a hospital, this is acute care, which is rarely a planning option because those who need hospitalization are admitted due to medical necessity, not planning.

Nursing Home Care -- Intermediate or Skilled Level of Care. This type of care is provided for in a nursing home and can include rehabilitation after a hospitalization. It requires nursing staff 24/7.

Residential Care or Assisted Living. A step below skilled or intermediate care, this type of care is provided in a facility and is designed for those who don’t need skilled or intermediate services, but who do require varying degrees of supervision and assistance with some activities of daily life. The primary difference between a nursing home and a residential care facility is the absence of nurses, although some assisted living facilities have nurses available or on staff.

Home Care. Home care is generally limited to those who are able to operate with sufficient independence or who have a family structure that allows them to remain at home. In some instances, sitters are used on some basis (www.homeinstead.com), but this can get pricey. It may be possible to secure nursing assistance through various Home Health agencies, and if the family member meets the criteria, Medicare may pay for this service although the requirements are very strict. To alleviate some of the family burdens, many people use Adult Day Care facilities.

Next Week: How to Pay for Long-Term Care